The Strong Heart Study is a study of cardiovascular disease (CVD) American Indians. The study involves 12 Indian communities in Arizona, Oklahoma and North and South Dakota. Phase I, which began on October 1, 1988, included a medical record review to determine mortality rates for CVD in individuals age 35 to 74 years between 1984 and 1988 and morbidity rates for individuals age 45 to 74 in the same time interval. In addition, a physical examination was performed on all individuals 45 to 74 years old to measure prevalence of cardiovascular and peripheral vascular disease and known and suspected risk factors. This application proposes an extension (Phase II) of the Strong Heart Study in which the mortality survey will be continued, 'and the cohort of men and women examined during Phase I will be followed and re-examined. The aims of Phase II are to determine CVD mortality and morbidity rates in an examined cohort and to determine their CVD risk factors, the changes in risk factors over time, and the relationship between risk factors and CVD. Additional aims are to compare CVD risk factors at the three centers, to relate them to differences in the rates of CVD, to assess and compare risk factors for CVD among diabetic and non-diabetic individuals, to investigate structural and functional cardiac disease using echocardiography, and to study pulmonary function to identify risk factors for pulmonary disease and their relationships to CVD. Additional laboratory measurements will be added to expand the number of possible correlates with CVD (i.e., Lp(a), plasminogen and plasminogen activator inhibitor), and to assess degree of genetic admixture. This application is for the Dakota field center and the Electrocardiography Reading Center of the Strong Heart Study Phase II.